Russo, Marc S

Russo, Marc S is an individual health care provider with primary practice located at 562 W 2Nd Ave , Lititz PA 17543-1816. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Russo, Marc S can be contacted via phone (717) 626-2167.

Contact Information

Primary practice address
562 W 2Nd Ave Lititz PA 17543-1816
Phone: (717) 626-2167
Fax: (717) 626-1915
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD042622L Pennsylvania

Profile Details

NPI number 1427033927
LBN Legal business name Russo, Marc S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 7th, 2005
Last updated Sep 1st, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427033927 NPPES
Pennsylvania Other 578413 AETNA HMO
Pennsylvania Other P002686 AETNA HMO
Pennsylvania Other G05182 AETNA HMO
Pennsylvania Other 02110901 AETNA HMO
Pennsylvania Other 36691 S1QG AETNA HMO
Pennsylvania Other 5487080 AETNA HMO
Pennsylvania Other 775158 AETNA HMO
Pennsylvania MEDICAID 0015140170004 AETNA HMO
Pennsylvania MEDICAID 0015140170001 AETNA HMO

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